Provider Demographics
NPI:1861797342
Name:JEFFREY L. BENDER, D.C., INC.
Entity type:Organization
Organization Name:JEFFREY L. BENDER, D.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:505-865-7610
Mailing Address - Street 1:PO BOX 2927
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-2927
Mailing Address - Country:US
Mailing Address - Phone:505-865-7610
Mailing Address - Fax:505-865-8673
Practice Address - Street 1:209 HIGHWAY 314 NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6697
Practice Address - Country:US
Practice Address - Phone:505-865-7610
Practice Address - Fax:505-865-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU44752Medicare UPIN